ACKNOWLEDGMENT OF JUVENILE DIVERSION RECORD SEALED 
(Welf. & Inst. Code, § 786.5)

Probation Dept., County of

JV-589

YOUTH'S NAME:

Under Welfare and Institutions Code section 786.5, agencies must advise the probation department of their compliance with the 
probation department's sealing notification. Please return this completed Acknowledgment of Juvenile Diversion Record Sealed to the 
probation department upon sealing of the records.

INSTRUCTIONS

TO THE PROBATION DEPARTMENT: I certify that the records required to be sealed pursuant to the notification from the 
probation department have been sealed, and a copy of this acknowledgment of record sealed has been sent to the probation 
department advising it of compliance with the probation department notice.

2.  Date of Probation Department Notice:

Youth's Name:

Agency Name:

Date of Birth:

1. 

3.

4.

Date:

By:

(TYPE OR PRINT YOUR NAME)

(SIGNATURE)

Form Approved for Optional Use 
Judicial Council of California 
JV-589 [New January 1, 2022]

ACKNOWLEDGMENT OF JUVENILE DIVERSION RECORD SEALED 
(Welf. & Inst. Code, § 786.5)

Page 1 of 1

Welfare and Institutions Code, § 786.5 



JV-589 ACKNOWLEDGMENT OF JUVENILE DIVERSION RECORD SEALED
(Welf. & Inst. Code, § 786.5)

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